Provider Demographics
NPI:1295359529
Name:MA DENTAL PLLC
Entity Type:Organization
Organization Name:MA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARWA
Authorized Official - Middle Name:
Authorized Official - Last Name:JABER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-977-0291
Mailing Address - Street 1:6501 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-4780
Mailing Address - Country:US
Mailing Address - Phone:313-424-4470
Mailing Address - Fax:313-281-2225
Practice Address - Street 1:6501 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-4780
Practice Address - Country:US
Practice Address - Phone:313-424-4470
Practice Address - Fax:313-281-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245600253OtherPERSONAL NOI